Orthostatic hypotension (OH) is the most disabling manifestation of autonomic failure and many other medical conditions, including diabetes. Orthostatic hypotension can also be seen as a consequence of medications and even aging. For example, drugs that increase vascular resistance (e.g., midodrine) and/or plasma volume (e.g., fludrocortisone) are first-line therapy. Such drugs, however, may worsen supine hypertension and may be contraindicated in patients with significant cardiovascular disease (e.g., congestive heart failure). More importantly, these approaches to treatment do not target the main reason blood pressure (BP) falls on standing, which is gravity-related venous pooling that reduces venous return and cardiac output. Most of this venous pooling occurs in the splanchnic circulation.
Abdominal compression is a safe and effective approach to improve standing BP. Thus, it is considered the standard of care in the non-pharmacologic treatment of neurogenic OH. This recommendation, however, is based on acute studies (i.e., less than two hours). And there are no controlled trials that have proven the continued efficacy of this approach, much less patient acceptance. Indeed, evidence suggests that this approach is not effective in most patients mostly due to decreased efficacy and low compliance. The limitations with currently available devices, such as elastic abdominal binders are explained by the fact that it is difficult for patients to apply pressure at an effective compression level (e.g., 20-40 mm Hg). Not only does this reduce efficacy of currently available compression devices, but such devices are also uncomfortable to wear for prolonged periods of time if kept at effective compression levels.